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Date : 01/20/98
Page : 1

JFK ASSASSINATION SYSTEM
IDENTIFICATION FORM

AGENCY ‘INFORMATION

_ AGENCY : INSCOM/CSF
RECORD NUMBER : 194-10004-10143
RECORDS SERIES : DOD-AFFILIATED PERSONNEL INCIDENT INVESTIGATIONS
AGENCY FILE NUMBER : PAGES 384-385

DOCUMENT INFORMATION

ORIGINATOR : USA
FROM : HEADQUARTERS, USAINTC
TO :
TITLE : [ RESTRICTED ]
DATE : 01/18/67 —
PAGES : 2
SUBJECTS : FROMER, DAVID R.

LEGAL ADVICE

DOCUMENT TYPE : PAPER, TEXTUAL DOCUMENT
CLASSIFICATION : UNCLASSIFIED
RESTRICTIONS : 3
CURRENT STATUS : RELEASED WITH DELETIONS
DATE OF LAST REVIEW : 03/07/95
OPENING CRITERIA :
COMMENTS : -

’ NW 88613 Docid:34520584 Page 1

—
ete ST
1. DATE OF REQUEST
> LAS, NA fee <n - MIDDLEaN MES  ALIASIES? = NICKNAMES ” CHANGED "NAME 4. SOCIAL SECURITY NO.
FROMER, David Reed “>. 4 «) . 564-58-8137
5. DAY. MONTH, YEAR OF BIRTH 6. PLACE OF BIRTH ; 7. SERVICE NUMBER a
[aa duly 1902 _(enteago, Cook, Ta14nots fed

6. RELATIVE'S NAMES 9. OATE AND PLACE OF BIRTH . 19. PRESENT ADDRESS | 11. CITIZENSHIP | | 11. CITIZENSHIP |

0. FATHER 12 Jal 1913 13 Rhonda Way ee |
Mill Valley, Calif. Pe

Irving Fromer Cincinnati, Ohio ]
13 Rhonda Way
12, RESIDENCES (List all from 16th birthday or during last 15 years, whichever is shorter)

Katherine modes [isthervitie
Katherine Rhodes Estherville, Iowa Mill Valley, Calif

¢. SPOUSE (moiden nome}

San Francisco Calif.
Berkeley Calif.
Sen Francisco /|Calif.

None

c. NUMBER AND STREET
1932 Cabrillo St.
2450 Bencroft Way
881 Clayton St.

219 N. Basset Madison Wisconsin
2 ue aire Lawn Ave. Madison Wiscons

Mad son ; Wiscons

iS <I One nid Peichdey or during last 15 years,
Dec 1959
Sumer '6

- 1960

Fairmont Hotel
Foster's Restaurant
Madison Board of fete

San Francisco, Calif.
San Francisco, Calif.
Madison, | Wisconsin

NAME

* University of Wisconsin

a. 1966 b. to
Present

ee f any QUALIFICATION OF DD FORM 398 OR DD FORM 92: -.

[ {Xo any annesr on coun eecono? na

16. REMARKS (If additional space is needed, continue on plain paper) .

Item 12. 1966 to Present 13 Rhonde Way, Mil@VaFicy¥ & 1a

1966 to Present 140 Langdon Street, Madigon, Wisconsin

Item 13. Oct 65 50 June 66 Cooks Cupboard, 1718 Walls St., Chicago, Illinois
Employer: Bob Geroge Reason: Return to S. F.

Item 15. Registrant refused to execute DD Form 98 and explained in the remarks sectiog.

Also refused to answer Item 17 and; ‘anewered affirmatively Itemi19“and

explained in the remarks section. Refused to be fingerprinted also. (wer) BB

18. FROM:

HEADQUARTERS, USAINTC
ATIN: ICOP-ITI -31

Fort Holabird Md.

21219

ud

FINGERPRINT CARD FD 258 MUST BE ATTACHED CORRE Y

D A nue es 3 O 2 ne termination e tr ’

ag

_ NW 88613 Docid:34528584 Page 2


(6353-6004) 18 Jan 67
FROMER, David Reed
DPOB: 21 Jul 423 Chicago, Dlinois

Con't = Item 16 (Remarks)

Item 15 - SUBJECT explained in the "Remarks" section as follows: "(I have not
done anything that I am not proud of) - I have been advised by my attorneys that
I cannot sign this form without placting myself in jeapardy: Peter Franck -
personal attorney, Vincent Hallinan - family attorney."

FBI reports, San Francisco, California, titled: David Reed FROMER, with
Bureau File #: 100-433071, dating from 3 May 1960 to the latest dated 23
November 1966, are in the possession of this office. Request any additional
and/or subsequent information. ,

—
er

NW 88613 Docid:34528584 Page 3

